Federal practitioner : for the health care professionals of the VA, DoD, and PHS最新文献

{"title":"Evaluating Use of Empagliflozin for Diabetes Management in Veterans With Chronic Kidney Disease.","authors":"Chelsey Williams, Bobbie Bailey","doi":"10.12788/fp.0524","DOIUrl":"10.12788/fp.0524","url":null,"abstract":"<p><strong>Background: </strong>About 1 in 4 veterans have diabetes, and many also have chronic kidney disease (CKD). Empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, is approved for the treatment of diabetes. The purpose of this study was to evaluate the effectiveness of empagliflozin on hemoglobin A_1c (HbA_1c) in patients with CKD.</p><p><strong>Methods: </strong>A retrospective chart review evaluated patients that had a type 2 diabetes diagnosis and stage 3 CKD prescribed empagliflozin for diabetes management between January 1, 2015, and October 1, 2022. Patient demographics, medication, HbA_1c levels, and other data were collected from a random sample of 100 patients from 1771 potential study subjects.</p><p><strong>Results: </strong>There was no statistically significant difference in changes in HbA_1c levels between those with stage 3 and stage 3b diabetes CKD who were taking empagliflozin (<i>P</i> = .51). Within each group, there were significant statistical differences in changes in HbA_1c for patients with stage 3a (<i>P</i> < .05) and stage 3b (<i>P</i> = .02). Patients with stage 3a had a reduction in HbA_1c of 0.65% and the stage 3b grow had a 0.48% reduction. There was a statistically significant weight change for patients in the stage 3a group (<i>P</i> < .05). Statistically significant differences were found in systolic (<i>P</i> = .003) and diastolic (<i>P</i> = .04) blood pressure for the stage 3a CKD group only. The most common adverse effects leading to discontinuation of empagliflozin were dizziness, increased incidence of urinary tract infections, and rash.</p><p><strong>Conclusions: </strong>Empagliflozin is a favorable option for reducing HbA_1c levels in patients with diabetes and CKD.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 5","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Studies in Continuous Glucose Monitoring.","authors":"Eden M Miller","doi":"10.12788/fp.0529","DOIUrl":"10.12788/fp.0529","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 6","pages":"S1-S6"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Veteran's Canon Under Fire.","authors":"Cynthia M A Geppert","doi":"10.12788/fp.0528","DOIUrl":"https://doi.org/10.12788/fp.0528","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 11","pages":"356-357"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevating the Importance of Asthma Care in the United States.","authors":"Gary C Steven, Neil Skolnik, Mike Devano, Wendy L Wright, Maureen George","doi":"10.12788/fp.0531","DOIUrl":"10.12788/fp.0531","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 6","pages":"S13-S22"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypercortisolism Is More Common Than You Think-Here's How to Find It.","authors":"Pamela Kushner, David R Brown, Robert S Busch","doi":"10.12788/fp.0532","DOIUrl":"10.12788/fp.0532","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 6","pages":"S23-S28"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving COPD Management at Transitions of Care.","authors":"Alan Kaplan","doi":"10.12788/fp.0533","DOIUrl":"10.12788/fp.0533","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 6","pages":"S29-S34"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Finerenone in Optimizing Cardiovascular-Kidney-Metabolic Health: Everything PCPs Should Know.","authors":"Eugene E Wright, Richard B Frady, Chigozie Uko","doi":"10.12788/fp.0535","DOIUrl":"10.12788/fp.0535","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 6","pages":"S41-S46"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact and Recovery of VHA Epilepsy Care Services During the COVID-19 Pandemic.","authors":"Zulfi Haneef, Erin Sullivan-Baca, Rizwana Rehman, Alan Towne, Ann C Van Cott, Aatif Husain","doi":"10.12788/fp.0488","DOIUrl":"10.12788/fp.0488","url":null,"abstract":"<p><strong>Background: </strong>The Epilepsy Centers of Excellence (ECoE) is a network of facilities within the Veterans Health Administration that evaluates and treats veterans with epilepsy and seizure disorders. This article outlines how the COVID-19 pandemic impacted ECoE services and recovery.</p><p><strong>Methods: </strong>Directors of 17 ECoEs were surveyed 4 times between May 2020 and July 2022 on 5 domains: functioning of outpatient epilepsy clinics, outpatient electroencephalogram, epilepsy monitoring unit, anticipated permanent operational changes, and utility of national and local recommendations. Data on the spread of COVID-19 and administrative workload data were compared with the availability of epilepsy services.</p><p><strong>Results: </strong>There was an increase in in-person outpatient visits from May 2020 (1 of 13 sites) to June 2022 (all 16 sites). Similar increases were also observed for outpatient electroencephalogram from 4 of 13 sites and subsequently all 16 sites, and for epilepsy monitoring unit from 1 of 12 sites to 11 of 16 sites. The spread of COVID-19 did not correlate with the availability of services. Respondents predicted telehealth would be a permanent change.</p><p><strong>Conclusions: </strong>Comprehensive ECoEs within the Veterans Health Administration increased services during the COVID-19 pandemic without demonstrating an association to the disease's spread.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 11","pages":"370-375"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring vs Fingerstick Monitoring for Hemoglobin A_1c Control in Veterans.","authors":"Kelsey Floerchinger, Kelley Oehlke, Scott Bebensee, Austin Hansen, Kelsey Oye","doi":"10.12788/fp.0525","DOIUrl":"10.12788/fp.0525","url":null,"abstract":"<p><strong>Background: </strong>Patients with diabetes have traditionally been required to use fingerstick testing to self-monitor their glucose levels. However, continuous glucose monitors (CGMs) collect glucose readings throughout the day and display daily trends, which allow clinicians to individualize treatment to achieve hemoglobin A_1c (HbA_1c) goals and simplify medication regimens. While studies have shown that CGMs improve HbA_1c levels compared to fingerstick testing, this research has focused on type 1 diabetes and excluded veterans and patients on insulin therapy.</p><p><strong>Methods: </strong>This retrospective chart review used a crossover, self-controlled design conducted at the Veterans Affairs Sioux Falls Health Care System. Veterans with an active CGM prescription were included. The primary endpoint compared the change in HbA_1c before and after initiation of a CGM.</p><p><strong>Results: </strong>The mean baseline HbA_1c for the 150 veterans included in this study was 8.6%. The change in HbA_1c before CGM use was 0.003 and change in HbA_1c after CGM use was -0.971. The primary endpoint of difference in HbA_1c associated with CGM use was -0.969 (<i>P</i> = .0001). The overall mean change in total daily doses of insulin was -22 units. Subgroup analysis of change in HbA_1c after CGM use by prescriber type was -0.97 for endocrinology, -0.7 for pharmacy, and -1.23 for primary care practitioners. The overall average HbA_1c post-CGM use was similar across all prescriber types at 7.64%.</p><p><strong>Conclusions: </strong>This study found veterans with type 2 diabetes and on insulin therapy demonstrated a significant reduction in HbA_1c with CGM use compared with their baseline fingerstick monitoring. Use of a CGM may be beneficial in patients who require a reduction in HbA_1c by allowing more precise adjustments to medications to optimize therapy.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 5","pages":"S1-S5"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection and Diagnosis of Early Symptomatic Alzheimer's Disease in Primary Care.","authors":"Dani Cabral, Thomas O Obisesan","doi":"10.12788/fp.0530","DOIUrl":"10.12788/fp.0530","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 6","pages":"S7-S12"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}